| Objective: Anaphylactoid purpura or Henoch-schonlein purpura(HSP) is a rheumatic autoimmune disease which is frequently founded in children in recent years. Kidney damage is the main factor to determine its prognosis, and early detection, early prevention is crucial. The purpose of this article is to explore the relationship between procalcitonin(PCT), D-Dimer, Cystatin c(Cys C) and the HSP, which can be made use of the clinical to judge the renal damage of HSP and get clinical study value. And then it can early guide clinical treatment and prognosis, to reduce the risk of kidney damage and improve the cure rate.Method: 1 The objects of study Choose 101 children with HSP as objects. They have been first treated in pediatric kidney departmentin the Second Hospital of Hebei Medical University professional in hospital from May, 2014 to May, 2015. 11 of them are lost to follow-up, which is not included in the statistics, and the rest 90 cases of children are qualified, including 59 boys and 31 girls. They are aged between 3 to 13 years old, average age 7.17+/-2.82.The diagnosis of HSP basis: HSP can cause the typical rash with or without gastrointestinal symptoms, including abdominal pain, hematochezia, joint swelling and kidney damage. And if Blood platelets indicated not low can also be diagnosed as HSP. Henoch-schonlein purpura nephritis(HSPN) is the secondary kidney damage caused by HSP. Clinical manifestations are hematuria and(or) proteinuria, part can be associated with high blood pressure and renal insufficiency. HSPN is the most common secondary glomerulonephritis. Most patients’ prognosis is good, but a minority will not be cured completely because of the disease replase, and eventually may lead to end-stage renalfailure, which seriously affects the quality of life. Kidney damage often appears in six months after the first onset of HSP, and from the second week to the fourth week is the peak period of kidney damage. HSPN diagnosis for: a period of 6 months HSP pathogenesis, hematuria or(and) proteinuria can be diagnosed. 2 The method of study The 90 cases of children were checked about three items within 24 hours after admission, including serum PCT, D-Dimer and Cys C. All of the children were divided into two groups according to test results. The positive ones were Group A(Positive Group), the negative ones were listed as Group B(Negtive Group). After admission, children got conventional and professional treatments(bed rest, anti-inflammatory, anticoagulation, improve circulation and protect the kidney, regulating immunity, etc). They would have a second test after 2-week active treatment about the previous three items, and on the basis of test results grouping: A1 for those who havn’t changed into negative ones. A2 for those who have changed into negative ones. PCTAll children were followed up for 6 months, to observe and compare the incidence of kidney damage of each group, so that we can get statistical analysis。 3 The methods of detection 3.1 Detection of PCT The sample children are all in the extraction of 2ml venous blood within 24 h after admission. With the help of solid phase immune chromatography technology and double antibody clip art, people can detect human calcitonin in whole blood. Blood lits would be balance out to room temperature, shaked well whole blood specimens, and took 80μL as sampler, then a few drops would be put in the sample kit with holes. 15 minutes later, people would add sample kit immediately on immune quantitative analyzer and rapidly detect, then we can read the quantitative results, PCT normal<0.5 ng/ml. 3.2 Detection of D- dimer By the principle of immune turbidimetry, people used spectrophotometers to test the absorbance changesof suspension containing latex particles. Withthe increase of absorbance we can detect the level of antigen in the specimen. Instruments were France Stago automatic instrument of coagulation, and DDimer normal<0.23 μg/ml. 3.3 Detection of Cys C All the children were extracted 5ml venous blood within 24 hours when they were admitted to the hospital, and within 3 hours the blood were centrifugal separated at a speed of 3000 r/min for 15 minutes, and the serum were put in ethylenediamine tetraacetic acid(EDTA) anticoagulant tube, placed to 40 refrigerator. Serum or EDTA plasma was send to the hospital ℃clinical laboratory testing Cys C within 30 minutes. Used the instrument of automatic biochemical analyzer being future-proof AU640 Japan. Bright with sea view source medical instrument co, LTD.(inhibition C detection kit(immune turbidimetry). Cys C normal<1.02 mg/L. 4 Statistical analysis Apply SPSS13.0 to experimental data, and I will give a full description and statistical analysis. Observation group and control group with age line normality test, for normal distribution, it is used to mean +/-standard deviation(x+/-S), using t test is compared among groups; For non-normal distribution, it is adopted median(interquartile range)(Q)(M) description, and comparison among groups use the nonparametric method; Gender differences among groups were compared by chi-square test, and P<0.05 was statistically significant; Differences among groups in renal injury were compared by chi-square test, and P<0.05 was statistically significant. While n<46, and due to the theoretical frequency1<=T<5 chi-square value, it would be correct, if n<46, or T<1, I would take Fisher’s exact probability method as hypothesis testing.Results: 1 Group A and group B with age: Children of Group A were aged 7.57+/-2.61, while group B were aged 7.17+/-2.82. There was no statistically significant difference between the two(t = 0.486, P>0.05); 2 The group A and group B with the comparison of incidence of renal injury: Children of Group A including 49 kids, kidney damage rate was 42.9%(21/49), while Group B with 41 cases, kidney damage rate was 17.1%(7/41). The incidence of kidney injury in children with similarities between the two groups has statistical significance(X~2=6.924, P<0.05). Positive indicators can increase the incidence of kidney damage; 3 A1 and A2 group children with kidney injury incidence of comparison: A1 group with 23 cases, renal injury incidence rate was 69.6%(16/23), while A2 group of children with 26 cases, renal injury incidence rate was 19.2%(5/26), the incidence of kidney injury in children with similarities between the two groups have statistical significance(X~2=12.626, P<0.05). And it indicates that positive indicators continue to higher value for the forecast of kidney damage; 4 Comparision about probabilities of rach group to cause Each kidney damage: Index for the suatain positive incidence of kidney injury in children69.6%>obsered group 42.9%>turning negative group 19.2%>the control group 17.1%; 5 PCT children with positive group compared with the incidence of kidney injury in children with group B: PCT children with positive were 5 cases, renal damage rated 20%(1/5), and Group B patients, 41 cases of renal injury incidence rated 17.1%(7/41), so there was no statistically significant difference in two groups of children with renal injury(X~2=0.027, P> 0.05), it can’t be concluded that the PCT is associated with HSP children with renal damage; 6 D-Dimer children with positive group compared with the incidence of kidney injury in children with Group B: D-Dimer positive patients, 21 cases of kidney injury incidence rated 42.9%(9/21), and Group B patients, 41 cases of kidney injury incidence rated 17.1%(7/41). There was statistical significancebetween the two groups(X~2=4.822, P<0.05), D-Dimer positive incidence of kidney injury in children with obvious rise, can be used as evaluation index of prognosis of children with HSP:D-Dimer index sustained positive group(Group C) children with 8 cases, renal injury incidence rated 75%(6/8), D-Dimer turn negative group(Group D) children with 13 cases,renal injury incidence rated 23.1%(3/13), so there was statistical significance between the two groups(P(Fisher’s Exact Test)<0.05). It can be concluded that D-Dimer index sustained positive suggests the greater the chance of kidney injury, the worse prognosis; 7 Cys C children with positive group compared with the incidence of kidney injury in children with Group B: Cys C positive with 23 cases, the incidence of renal injury was 47.8%(11/23), and Group B patients, 41 cases of kidney injury incidence rated 17.1%(7/41). There was statistical significance between the two groups(X~2 = 6.893, P<0.05). It suggested that Cys C positive incidence of kidney injury in children with obvious rise, can be used as evaluation index of prognosis of children with HSP. Cys C index sustained positive group(Group E) children with 15 cases, the incidence of renal injury was 66.7%(10/15). Cys C turns negative group(Group F) children with 8 cases, the incidence of renal injury was 12.5%(1/8). There was statistically significant between the two groups(P(Fisher’s Exact Test)<0.05). It suggested that Cys C continued positive significantly increases the risk of renal injury.Conclusions: 1 D-Dimer, Cys C index sustained positive greatly increase the chance of renal injury. It may result from early small blood vessels caused by dysfunction of blood coagulation and inflammatory lesions involving the kidney with extensively, which provide the basis for the combination of early renal damage diagnosis. 2 D-Dimer lasts electropositive kidney damage probability increase greatly, which confirmed that HSP pathogenesis are abnormal blood coagulation and fibrinolytic mechanism, and those are may be the root cause of renal injury. 3 D-Dimer, Cys C HSPN can be used as the early prediction of indicators, and as indicators of infection, PCT can only represent the early infection status, but cannot predict prognosis of children with HSP kidney injury situation, which prompt HSP early infection( especially the bacterial infection) generally not heavy. |
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